Town of Algoma Fire Department Investigation

• Fire Location/Site
  Address

• What was the Date and Time if the Fire

  Date

• Date of Scene Investigation

  Date

• Prepared by If Not An Investigator

• Name of Certified Investigator

Incident Number

• What is the Run Number

Property Owner

• Please enter all property owners:

Property Owner

• Property owner name:

• Phone number:

• E-mail address:

• Mailing address:
  Address

• Photo of the ID of owner:

  Media

Tenant Information

• Please enter all tenants/ businesses on site if not the property owner name:

Tenant(s)/ Business(s)

• Tenant/ business owner name:

• Phone number:

• E-mail address:

• Mailing address:
  Address

• Photo of the ID of tenant:

  Media

Property Information

• Do they have insurance?

  Yes

  No

  N/A

• Insurance company name/ phone number:

• Is there a loan on the property?

  Yes

  No

  N/A

• Finance company name/ phone number:

Tenant Needs

• Do they need a board up company?

  Yes

  No

  N/A

• undefined

  Select

• Do they need Red Cross assistance?

  Yes

  No

  N/A

• undefined

  Select

Victim/ Witness Statement(s)

• Please have each witness give a statement as needed:

Witness

• Category:

  Owner

  Occupant

  Witness

  1st Responder

• Name:

• Photo of witness ID, or photo of witness:

  Media

• Date and time of witness statement:

  Date

• What happened in their words?

• Photo of witness statement:

  Media

• Witness signature:

  Sign

Consent Forms

• I understand the Town of Algoma Fire Department was called to my property for an incident. Although not needed I give consent for the TOAFD permission to investigate my property to complete Origin and Cause investigation.

  Sign

• Town of Algoma Fire Department Consent Form (ONLY REQUIRED IF RETURNING TO THE PROPERTY AFTER RELEASE BACK TO THE PROPERTY OWNER)

• I have read and understand the Consent to Search Form and was provided a copy. I Give consent to search my Property.

  Sign

• www.wunderground.com Capture a screen Shot of Current Weather

• Add captured Screen Shots Here

  Media

• Date of the incident

  Date

• Exact time and date of investigation

  Date

• Take a photo of the object, structure or area that was burned

  Media

• Describe physical characteristics of what was burned. Give dimensions when possible and detailed descriptions.

• Take photo of the surrounding

  Media

• Describe main streets and access to building or property. Also, weather conditions when applicable.

• Who requested the response?

• Who was dispatched to investigate?

Recommendation

• State the recommendations from the investigative team in relation to the fire itself

Processing the Scene

Risk Assessment

• During the process of examination, efforts were conducted to determine if any safety related conditions could be identified which may cause me (or any other individual) physical harm as a result of anticipated investigative efforts. Beyond the personal safety gear normally associated with fire investigation, (e.g., eye, hand, respiratory, and footwear protection), No safety concerns were identified that required immediate attention. As the examination progressed, continued attention was focused on identifying and addressing safety concerns as they became evident.

  Safe

  At Risk

  N/A

• If Safety Concerns are present please check of PPE Used

  Select Boots Gloves Respirator Eye Protection Air Monitoring

  • Boots
  • Gloves
  • Respirator
  • Eye Protection
  • Air Monitoring

Investigator Exposure Report

• List all PPE worn by investigators, approximate time spent inside fire building, any noteworthy exposures, injuries, or illnesses incurred in relation to this investigation

Attach or Link Any Audio/Video Interview Files

• Description of Audio/Video Content

• Current weather conditions:

• Is this a structure?

  Yes

  No

  N/A

• Exterior photos: Pictures of the address numbers on mailbox and/ or house, then starting on the Alpha side of the structure, Bravo, Charlie, and then Delta:

  Media

• Are there any exposures?

  Yes

  No

  N/A

• Enter each exposure separately:

Exposure

• Location and description of exposure:

• Photos of exposure:

  Media

• Pictures of the initial entry point:

  Media

• Photos of each room:

  Media

• Area of origin and point of origin if known:

  Media

• Is this a mobile property?

  Yes

  No

  N/A

• Mobile Property: Make, Model, Year:

• Exterior photos: Picture of the license plate and Vehicle Identification Number (VIN), then starting at the front of the mobile property moving clockwise to each side of the mobile property:

  Media

• Are there any exposures?

  Yes

  No

  N/A

• Enter each exposure separately:

Exposure

• Location and description of exposure:

• Photos of exposure:

  Media

• Area of origin and point of origin if known:

  Media

• Add captured Screen Shots Here

  Media

Arson Checklist

• Signs of Forced Entry?

  YES

  NO

  N/A

• Multiple Seats of Fire?

  YES

  NO

  N/A

• Presence of an Accelerant?

  YES

  NO

  N/A

• Covered External windows?

  YES

  NO

  N/A

• Internal Doors Wedged Open?

  YES

  NO

  N/A

• Is the Fire in an Unusual Location?

  YES

  NO

  N/A

• Is the Fire Considered to be Deliberate?

  YES

  NO

  N/A

• Provide further details as required

• If yes to any above question STOP and inform Command of findings! Command to inform Law Enforcement!

Investigation

• Establish a fire cause

  Accidental

  Criminal

Fire caused by accident

• Who discovered the fire?

• Where did the fire start?

• Describe fire/s type (e.g electrical fire, fire from cooking, fire from combustible materials)

• Describe problems that may have contributed to the fire

• Are there witnesses?

  Yes

  No

• Interview witnesses and write their statements here

Witness

• Name of Witness

  Sign

• Details of the incident

• Who extinguished the fire?

• Are there victims?

  Yes

  None, all are safe

• How many were injured?

• How many died?

• List names and state condition of the victims

Fire caused by crime

• Who discovered the fire?

• Where did the fire start?

• Describe fire/s type (e.g electrical fire, fire from cooking, fire from combustible materials)

• Who are the suspect/s

• Describe the incendiary cause. This should be based solely from investigator observations. 1. How did the suspect arrive? 2. Why was the crime committed? 3. What are the materials used to start the fire?

• Provide photo of physical evidence of incendiary

  Media

• Write a negative corpus delicti through methodical elimination of all accidental, natural, and mechanical causes.

• Are there witnesses?

  Yes

  No

• Interview witnesses and write their statements here

Witness

• Details of the incident

• Name of Witness

  Sign

• Who extinguished the fire?

• Are there victims?

  Yes

  None, all are safe

• How many were injured?

• How many died?

• List names and state condition of the victims

• Record all legal statutes broken

Indicators

• Location Where the Fire Occurred (Description)

• Evidence from Glass Damage? (Description)

• Burn Patterns to Walls? (Description)

• Burn Patterns to the Floor? (Description)

• Burn Pattern to the Ceiling? (Description)

• Directional Burning? (Description)

• Smoke Damage (Description)

• Is Gas Involved?

  YES

  NO

  N/A

• Provide details

• Regardless take pictures of gas service to the residence.

  Media

• Is Electricity Involved?

  YES

  NO

  N/A

• Provide details

• Regardless take pictures of electrical service to the residence.

  Media

• Regardless take pictures of electrical service from the street.

  Media

• Were Combustible Materials too Close to ignition source?

  YES

  NO

  N/A

• undefined

• Were Ventilation/Flues Satisfactory?

  YES

  NO

  N/A

• undefined

• Is There Evidence of Faulty Controls

  YES

  NO

  N/A

• undefined

• Is There a History of Faults or Problems

  YES

  NO

  N/A

• undefined

• Is There Evidence of Misuse of Equipment/Appliances

  NO

  YES

• undefined

Naked Flames

• Candles, Lighter, Matches, Other

  YES

  NO

  N/A

• Provide details

Cooking

• Is Cooking Involved?

  YES

  NO

  N/A

• Provide details

Smoking

• Smoking Policy in Operation?

  YES

  NO

  N/A

• Ashtrays and Waste Bins Emptied?

  YES

  NO

  N/A

• Anyone Smoking Prior to the Fire?

  YES

  NO

  N/A

• Evidence of Previous Burn Marks Due to Smoking?

  YES

  NO

  N/A

• Previous Carelessly Discarded Cigarettes?

  YES

  NO

  N/A

• Provide further information if required?

Conclusion

• Point of Origin?

• Source of Ignition?

• What was the Item First Ignited?

• Hypotheses (What Were the Circumstances, Defects, Actions or Omissions that Brought the Fire about?)

• Further Investigation Information if Required

Completion

• Duly Approved by a Certified Fire Investigator (Name and Signature)

  Sign

• Name and Signature of the Documentor

  Sign

Conclusion

• Apparent Point of Origin

• Apparent Source of Ignition

• What Was the First Fuel Ignited?

• Hypotheses (What Were the Circumstances, Defects, Actions or Omissions that Brought the First Fuel and Source of Ignition Together?)

• INVESTIGATOR CHECKLIST: Has report PDF been uploaded to network Ops Incidents file? Has NFIRS criteria been documented in Emergency Reporting? Has building owner/occupant/RP been given copy of Application For Fire Records Request Form? Has Investigator Exposure Report been generated?

  NO

  YES

  PENDING

• TOAFD Release of Public Records Form for Building Owner or Designated Responsible Party

• Are you an Arson Investigator?

  Yes

  No

  N/A

Fire Scene Analysis

• It should be noted that the examination of the scene was conducted in accordance with all applicable suggested methods described in the National Fire Protection Agency (NFPA) 921, The Guide for Fire and Explosion Investigations.

• Draw a layout of the scene:

  Drawing

• Photo of scene sketch

  Media

• Forced entry?

  Yes

  No

  N/A

• Who forced entry?

• What department(s) where at the scene?

• What was described to you by the initial arriving companies?

• Describe what you see; exterior to the interior, and the un-burned to the burned:

Evidence

• Is there evidence being collected?

  Yes

  No

  N/A

• Entry for each piece of evidence:

Evidence

• Date and time evidence was collected

  Date

• Evidence number:

• Location of evidence:

• Photo of location of evidence:

  Media

• Photo of empty evidence container next to evidence:

  Media

• Photo of evidence in container with gloves next to container:

  Media

• Photo of evidence container sealed:

  Media

Hypothesis

• In order to reach my final conclusion in this matter, several different hypotheses were examined, studied, and considered as discussed in sections 17.5 through 17.7 of NFPA 921 in regards to how this fire may have originated. They are listed below:

• H1 Natural

  Yes

  No

  N/A

• H2 Accidental

  Yes

  No

  N/A

• H3 Incendiary

  Yes

  No

  N/A

• H4 Undetermined

  Yes

  No

  N/A

Determination of Origin and Cause

• Describe your hypothesis and what your opinion is about the origin and cause.

• I base this on the following evidence.

• Supporting pictures/ documents:

  Media

Additional Comments by the Investigator

• Additional notes:

• Additional photographs:

  Media

• Fire Department incident reports:

  Media

Signature (required each time report is modified):

• Name and signature of TOAFD personnel that completed report:

  Sign

• Date and time report is completed

  Date

• Duly Approved by a Certified Fire Investigator (Name and Signature)

  Sign